Physiological Adaptations to Sprint Interval Training with Matched Exercise Volume.

Purpose: To determine how high-intensity interval training (HIIT) protocols featuring matched times but distinct sprint durations affect cardiorespiratory and metabolic responses and performance. Methods: Thirty-eight recreationally active men (aged 21 +/- 2 years) were assigned to one of three interval training groups: long-duration high-intensity (HIIT60s; 8 x 60-s at 85%-90% V[spacing dot above]O2max; 120-s recovery at 30% V[spacing dot above]O2max), short-duration high-intensity (HIIT10s; 48 x 10-s at 85%-90% V[spacing dot above]O2max; 20-s recovery at 30% V[spacing dot above]O2max), and control (CON; regular physical activity without HIIT). Before and after a 4-wk training period (3 sessions per week), participants performed graded exercise tests and repeated-sprint tests, based on which their aerobic and anaerobic capacities were assessed. Skinfold thickness, blood and metabolic responses were also measured before and after intervention. Results: After 4-wk training, V[spacing dot above]O2max was significantly increased (P 0.05), but testosterone concentration in the HIIT10s was higher after training than before (P

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Objectively Measured Physical Activity and Cognitive Function in Older Adults.

Purpose: Emerging evidence suggests physical activity (PA) is associated with cognitive function. To overcome limitations of self-report PA measures, this study investigated the association of accelerometer-measured PA with incident cognitive impairment and longitudinal cognition among older adults. Methods: Participants were recruited from the cohort study, REasons for Geographic and Racial Differences in Stroke (REGARDS), in U.S. Accelerometers provided PA measures, including percent of total accelerometer wearing time spent in moderate-to-vigorous intensity PA (MVPA%), light-intensity PA and sedentary time, for 4-7 consecutive days at baseline. Cognitive impairment was defined by Six-Item Screener. Letter fluency, animal fluency, word list learning and Montreal Cognitive Assessment (orientation and recall) were conducted to assess executive function and memory. Results: Participants (N=6,452, 69.7 +/- 8.5 yr, 55.3% women, 30.5% black) with usable accelerometer and cognition measures spent extremely limited time in MVPA (1.5% +/- 1.9% of accelerometer wearing time). During an average of 3 years of follow-up, 346 cases of incident cognitive impairment were observed. After adjustments, participants in higher MVPA% quartiles had a lower risk of cognitive impairment (i.e. Quartile 2: OR=0.64, 95% CI: 0.48-0.84), and better maintenance in executive function (>=0.03 z-score units) and memory (>=0.12 z-score units), compared with Quartile 1 (P

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Analysis of Injury Mechanisms in Head Injuries in Skiers and Snowboarders.

Purpose: Mechanisms of injury and description of head impacts leading to traumatic brain injury (TBI) in skiers and snowboarders have not been extensively documented. We investigate snow-sport crashes leading to TBI in order to (1) Identify typical mechanisms leading to TBI to better target prevention measures and (2) Identify the injury mechanisms and the head impact conditions. Methods: The subjects were skiers and snowboarders diagnosed of TBI and admitted between 2013 and 2015 to one of the 15 medical offices and 3 hospital centers involved in the study. The survey includes the description of the patients (age, sex, practice, skill-level, and helmet use), of the crash (type, location, estimated speed, causes, and fall description) and of the injuries sustained (symptoms, head trauma scores, other injuries). Sketches were used to describe the crash and impact locations. Clustering methods were used to distinguish profiles of injured participants. Results: 295 skiers and 71 snowboarders were interviewed. The most frequent type of mechanism was falls (54%), followed by collision between users (18%), and jumps (15%). Collision with obstacle (13%) caused the most serious TBI. 3 categories of patients were identified. First, men aged 16-25 years are more involved in crash at high speed or in connection with a jump. Second, women, children (

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Birth Weight, School Sports Ability, and Adulthood Leisure-Time Physical Activity.

Purpose: To examine the associations of birth weight with ability in school sports in adolescence and participation in leisure-time physical activity (LTPA) across adulthood, and to investigate whether associations between birth weight and LTPA change with age. Methods: Study participants were British singletons born in 1946 and followed-up to age 68 (the MRC National Survey of Health and Development). Birth weights were extracted from birth records. Teacher reports of ability in school sports were collected at age 13 years. LTPA was self-reported at ages 36, 43, 53, 60-64 and 68 years and categorised at each age as participating in sports, exercise and other vigorous LTPA at least once per month versus no participation. Associations were examined using standard and mixed-effects logistic regression models. Results: Relevant data were available for 2,739 study participants (50.1% female). When compared with the low birth weight group (

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Quantitative Time-Profiling of Children's Activity and Motion.

Introduction: The aim was to establish children's mechanical movement patterns during a standardised assessment of fitness by means of an accelerometer. Further to this, our objective was to use the information from the accelerometer to profile individual time courses of exercise, across the cohort. Methods: A multi-stage fitness test study was performed with 103 children, aged 10.3 years +/- 0.6y. Children wore an ankle mounted accelerometer and gait data was collected on radial acceleration traces obtained at a frequency of 40 Hz. Time resolved metrics of foot impact force, maximum leg lift angle and stride frequency were used to profile children's performance across the test duration. A whole-history metric of stride quality, based on the changing ratio of stride length to stride frequency, was used in bivariate analyses of physical performance and body metrics. Results: Stride angle derived by our protocol was found to have a strong positive correlation with integrated acceleration, synonymous with counts, widely used in the sport science community (r = 0.81, r = 0.79 and r= 0.80 across different stages of the multi-stage fitness test). Accelerometer data show that differing performance in the test is related to the children's ability to accurately control their gait, with high performers displaying a linearly increasing speed, delivered through stride extension and well matched to the demand level of the test. A negative correlation was found between stride quality and body measures of BMI (r = -0.61), body mass (r = -0.60). Conclusion: Profiles of the gait parameters provide information on the mechanics of child's motion, allowing detailed assessment of multiple parameter during increasing intensities of exercise. (C) 2016 American College of Sports Medicine

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Kinematic Mechanisms of How Power Training Improves Healthy Old Adults' Gait Velocity.

Introduction: Slow gait predicts many adverse clinical outcomes in old adults but the mechanisms of how power training can minimize the age-related loss of gait velocity is unclear. We examined the effects of 10 weeks of lower extremity power training and detraining on healthy old adults' lower extremity muscle power and gait kinematics. Methods: As part of the Potsdam Gait Study (POGS), participants started with 10 weeks of power training followed by 10 weeks of detraining (n = 16) and participants started with a 10-week control period followed by 10 weeks of power training (n = 16). We measured gait kinematics (stride characteristic and joint kinematics) and isokinetic power of the ankle plantarflexor (20, 40, and 60[degrees]/s) and knee extensor and flexor (60, 120, and 180[degrees]/s) muscles at weeks 0, 10, and 20. Results: Power training improved isokinetic muscle power by ~30% (p

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Effects of Weight Loss on Lean Mass, Strength, Bone, and Aerobic Capacity.

Purpose: To evaluate the hypothesis that exercise attenuates the reductions in lean mass, muscle strength, BMD, and VO2max that accompany modest weight loss induced by calorie restriction. Methods: Overweight, sedentary women and men (n=52, 45-65y) were randomized to 6-8% weight loss by using calorie restriction (CR), endurance exercise (EX), or both (CREX). The CR and CREX groups underwent counseling to reduce energy intake by 20% and 10%, respectively. The EX and CREX groups exercised 7.4+/-0.5 and 4.4+/-0.5 hr/wk, respectively. Before and after 16.8+/-1.1 weeks of weight loss, lean mass and BMD were measured with dual-energy X-ray absorptiometry, strength was measured with dynamometry, and aerobic capacity (VO2max) was measured with indirect calorimetry during maximal-intensity treadmill exercise. Results: Weight loss was ~7% in all groups. Decreases in whole body (~2%, p=0.003) and lower extremity (~4%, p

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Strength Training and the Risk of Type 2 Diabetes and Cardiovascular Disease.

Purpose: To examine the association of strength training with incident type 2 diabetes and cardiovascular disease risk. Methods: We followed 35 754 healthy women (mean age, 62.6 years, range 47.0 - 97.8) from the Women's Health Study, who responded to a health questionnaire that included physical activity questions in 2000; assessing health outcomes through annual health questionnaire through 2014 (average (SD) follow-up = 10.7 (3.7) years). Incident type 2 diabetes (N cases = 2120) and cardiovascular disease (N cases = 1742) were confirmed on medical record review. Cases of cardiovascular disease were defined as confirmed cases of myocardial infarction, stroke, coronary artery bypass graft, angioplasty, or cardiovascular disease death Results: Compared to women who reported no strength training, women engaging in any strength training experienced a reduced rate of type 2 diabetes of 30% (hazard ratio: 0.70, 95% confidence interval: 0.61, 0.80) when controlling for time spent in other activities and other confounders. A risk reduction of 17% was observed for cardiovascular disease among women engaging in strength training (HR: 0.83, 95% CI: 0.72, 0.96). Participation in both strength training and aerobic activity was associated with additional risk reductions for both type 2 diabetes and cardiovascular disease compared to participation in aerobic activity only. Conclusions: These data support the inclusion of muscle-strengthening exercises in physical activity regimens for reduced risk of type 2 diabetes and cardiovascular disease, independent of aerobic exercise. Further research is needed to determine the optimum dose and intensity of muscle-strengthening exercises. (C) 2016 American College of Sports Medicine

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Different Effect of Local and General Fatigue on Knee Joint Stiffness.

Purpose: To investigate the influence of locally and generally induced fatigue on the stiffness properties of the knee joint. Methods: Twenty-two male (24.9 +/- 4.5 years, 1.78 +/- 0.06 m, 75.4 +/- 6.4 kg, 23.9 +/- 1.8 kg/m2) and eighteen female (21.1 +/- 1.5 years, 1.66 +/- 0.05 m, 63.4 +/- 6.5 kg, 22.9 +/- 2.5 kg/m2) amateur athletes participated. Peak torque (PT) of the knee extensor musculature, muscle stiffness (MS) of the vastus lateralis and musculoarticular stiffness (MAS) of the knee joint were assessed pre- and post- locally and generally induced fatigue (undertaken on two separate days with a one-week interval). Results: Males were characterized by higher values of MAS, relaxed and contracted MS, normalized PT (PT/body mass) and normalized MAS (MAS/external load) irrespective of time-point (p

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Effects of Motivational Self-Talk on Endurance and Cognitive Performance in the Heat.

Purpose: We tested the effectiveness of a two-week motivational self-talk (MST) intervention - specific to heat tolerance - on endurance capacity and cognitive function in the heat. Methods: Eighteen trained male (n=14) and female (n=4) cyclists randomly received two weeks of MST training (n=9) or a control regimen (CON, n=9). The experimental protocol was a PRE/POST design consisting of 30 min of cycling at 60% peak power output (PPO) in the heat (35[degrees]C, 50% relative humidity, ~3.0 m[middle dot]s-1 airflow), a 30 min rest period, followed by a time to exhaustion (TTE) test at 80% PPO, and an identical rest period. Executive function, reaction time, and working memory were tested at baseline and each rest period. Key measures included TTE, speed and accuracy on the cognitive tests, rectal temperature, heart rate, oxygen consumption, and rating of perceived exertion. Results: Group (MST vs. CON) x test (PRE vs. POST) x time repeated measures ANOVA revealed that MST significantly increased TTE from PRE (487+/-173 s) to POST (679+/-251 s, p = 0.021) concurrent with a higher terminating rectal temperature (PRE: 38.5 +/- 0.2[degrees]C, POST: 38.8 +/- 0.4[degrees]C, p=0.023; no TTE (PRE: 531+/-178 s, POST: 510+/-216 s, p = 0.28) or rectal temperature (PRE: 38.4 +/- 0.3[degrees]C, POST 38.4 +/- 0.2[degrees]C, p=1.000) changes were found in CON. MST significantly improved both speed and accuracy for executive function from PRE/POST, with no PRE/POST differences for CON on any cognitive measure. There were no interactions (all p > 0.05) for other key measures. Conclusion: Motivational self-talk is effective in altering the internal psychophysiological control of exercise and plays a role in improving endurance capacity and executive function in the heat. (C) 2016 American College of Sports Medicine

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Accuracy of Consumer Monitors for Estimating Energy Expenditure and Activity Type.

Introduction: Increasing use of consumer-based physical activity (PA) monitors necessitates that they are validated against criterion measures. Thus, the purpose of this study was to examine the accuracy of three consumer-based physical activity monitors for estimating energy expenditure and physical activity type during simulated free-living activities. Methods: Twenty-eight participants (mean +/- SD; age, 25.5+/-3.7 years; BMI, 24.9+/-2.6 kg/m2) completed 11 activities ranging from sedentary behaviors to vigorous intensities. Simultaneous measurements were made with an Oxycon portable calorimeter (criterion), a Basis Peak and Garmin Vivofit on the non-dominant wrist, and three Withings Pulse devices (right hip, shirt collar, dominant wrist). Repeated measures ANOVAs were used to examine differences between measured and predicted energy expenditure (EE). Intraclass correlation coefficients (ICC) were calculated to determine reliability of EE predictions between Withings placements. Paired samples T-tests were used to determine mean differences between observed minutes and Basis Peak predictions during walking, running, and cycling. Results: On average, the Basis Peak was within 8% of measured EE for the entire PA routine (p>0.05), however there were large individual errors (95% prediction interval, -290.4 to +233.1 kcals). All other devices were significantly different from measured EE for the entire PA routine (P=92% of actual minutes spent walking and running (p>0.05), and 40.4% and 0% of over-ground and stationary cycling minutes, respectively (p

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Effect of Ischemic Preconditioning on Endurance Performance Does not Surpass Placebo.

Purpose: Recent studies have reported ischemic preconditioning (IPC) can acutely improve endurance exercise performance in athletes. However, placebo and nocebo effects have not been sufficiently controlled, and the effect on aerobic metabolism parameters that determine endurance performance [e.g., oxygen cost of running, lactate threshold, and maximal oxygen uptake (V[Combining Dot Above]O2max)] has been equivocal. Thus, we circumvented limitations from previous studies to test the effect of IPC on aerobic metabolism parameters and endurance performance in well-trained runners. Methods: Eighteen runners (14 men/4 women) were submitted to three interventions, in random order: IPC; sham intervention (SHAM); and resting control (CT). Subjects were told both IPC and SHAM would improve performance compared to CT (i.e., similar placebo induction) and IPC would be harmless despite circulatory occlusion sensations (i.e., nocebo avoidance). Next, pulmonary ventilation and gas exchange, blood lactate concentration, and perceived effort were measured during a discontinuous incremental test on a treadmill. Then, a supramaximal test was used to verify the V[Combining Dot Above]O2max and assess endurance performance (i.e., time to exhaustion). Results: Ventilation, oxygen uptake, carbon dioxide output, lactate concentration, and perceived effort were similar among IPC, SHAM, and CT throughout the discontinuous incremental test (P > 0.05). Oxygen cost of running, lactate threshold, and V[Combining Dot Above]O2max were also similar among interventions (P > 0.05). Time to exhaustion was longer after IPC (mean +/- SEM, 165.34 +/- 12.34 s) and SHAM (164.38 +/- 11.71 s) than CT (143.98 +/- 12.09 s; P = 0.02 and 0.03, respectively), but similar between IPC and SHAM (P = 1.00). Conclusions: IPC did not change aerobic metabolism parameters, whereas improved endurance performance. The IPC improvement, however, did not surpass the effect of a placebo intervention. (C) 2016 American College of Sports Medicine

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Evaluating the "Threshold theory": Can Head Impact Indicators Help?.

Purpose: To determine the clinical utility of biomechanical head impact indicators by measuring the sensitivity, specificity, positive predictive value (PV+), and negative predictive value (PV-) of multiple thresholds. Methods: Head impact biomechanics (n=283,348) from 185 football players in one Division I program were collected. A multidisciplinary clinical team independently made concussion diagnoses (n=24). We dichotomized each impact using diagnosis (yes=24/no=283,324), and across a range of plausible impact indicator thresholds (10g increments beginning with a resultant linear head acceleration of 50g and ending with 120g). Results: Some thresholds had adequate sensitivity, specificity, and PV-. All thresholds had low PV+, with the best recorded PV+ less than 0.4% when accounting for all head impacts sustained by our sample. Even when conservatively adjusting the frequency of diagnosed concussions by a factor of 5 to account for unreported/undiagnosed injuries, the PV+ of head impact indicators at any threshold was no greater than 1.94%. Conclusions: While specificity and PV- appear high, the low PV+ would generate many unnecessary evaluations if these indicators were the sole diagnostic criteria. The clinical diagnostic value of head impact indicators is considerably questioned by these data. Notwithstanding, valid sensor technologies continue to offer objective data that have been used to improve player safety and reduce injury risk. (C) 2016 American College of Sports Medicine

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Maximal Fat Oxidation Rates in an Athletic Population.

Introduction: The aim of this study was to describe maximal fat oxidation (MFO) rates in an athletic population. Method: In total, 1121 athletes (933 males, 188 females), from a variety of sports and competitive level, undertook a graded exercise test on a treadmill in a fasted state (>=5 h fasted). Rates of fat oxidation were determined using indirect calorimetry. Results: Average MFO was 0.59 +/- 0.18 g[BULLET OPERATOR]min-1, ranging from 0.17 - 1.27 g[BULLET OPERATOR]min-1. Maximal rates occurred at an average exercise intensity of 49.3 +/- 14.8% V[spacing dot above]O2max, ranging from 22.6 - 88.8% V[spacing dot above]O2max. In absolute terms, male athletes had significantly higher MFO compared to females (0.61 and 0.50 g[BULLET OPERATOR]min-1 respectively, P

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Synergy 8 & Crestline Coach announce Saskatchewan Pediatric Ambulance

SASKATOON, Canada — Crestline Coach is so pleased to be part of a true Saskatchewan Collaboration, "2016 Drive for Kids Campaign". In partnership with Synergy 8, the Children's Hospital Foundation of Saskatchewan, the Sandra Schmirler Foundation and many other sponsors a fully customized, state-of-the-art Pediatric Ambulance was designed and built for the province of Saskatchewan ...

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Advances in awareness monitoring technologies.

Purpose of review: Initial studies suggested that the use of processed electroencephalogram technology could significantly decrease the incidence of unintended intraoperative awareness events during general anesthesia. Subsequent work has cast doubts on these findings. This review will examine the current state of awareness monitoring. Recent findings: Recently published randomized controlled trials examining the use of the bispectral index during general anesthesia have not been able to show superiority over other forms of monitoring depth of anesthesia, such as end-tidal anesthetic-agent concentration. Additionally, there is current interest in utilizing the unprocessed electroencephalogram to ascertain depth of anesthesia and recent studies have demonstrated its use in preventing postoperative delirium. Summary: Although awareness monitors such as the bispectral index monitor may have benefit in patients in whom volatile anesthetic agents must be minimized - such as in hemodynamically unstable patients, or patients undergoing total intravenous anesthesia - these monitors do not appear to be useful for all patients. Copyright (C) 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Understanding medical device regulation.

Purpose of review: The purpose of this article is to provide a structural and functional understanding of the systems used for the regulation of medical devices in the USA and European Union (EU). Recent findings: Safe and effective anesthesia care depends heavily on medical devices, including simple, low risk devices to complex life-supporting and life-sustaining devices. In the USA and EU, the Food and Drug Administration and European Commission, respectively, provide regulatory oversight to ensure medical devices are reasonably safe and effective when used for their intended purposes. Unfortunately, practicing anesthesiologists generally have little or no understanding of how medical devices are regulated, nor do they have sufficient knowledge of available adverse event reporting systems. Summary: The US and EU medical device regulatory systems are similar in many ways, but differ in important ways too, which impacts the afforded level of safety and effectiveness assurance. In both systems, medical devices are classified and regulated on a risk basis, which fundamentally differs from drug regulation, where uniform requirements are imposed. Anesthesia providers must gain knowledge of these systems and be active players in both premarket and postmarket activities, particularly with regard to vigilance and adverse event/device failure reporting. Copyright (C) 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Anaesthesia in outer space: the ultimate ambulatory setting?.

Purpose of review: Missions to the Moon or more distant planets are planned in the next future, and will push back the limits of our experience in providing medical support in remote environments. Medical preparedness is ongoing, and involves planning for emergency surgical interventions and anaesthetic procedures. This review will summarize what principles of ambulatory anaesthesia on Earth could benefit the environment of a space mission with its unique constraints. Recent findings: Ambulatory anaesthesia relies on several principles such as improved patient pathway, correct patient selection, optimized procedural strategies to hasten recovery and active prevention of postoperative complications. Severe limitations in the equipment available and the skills of the crew members represent the key factors to be taken into account when designing the on-board medical system for future interplanetary space missions. Summary: The application of some of the key principles of ambulatory anaesthesia, as well as recent advances in anaesthetic techniques and better understanding of human adaptation to the space environment might allow nonanaesthesiologist physicians to perform common anaesthetic procedures, whilst maximizing crew safety and minimizing the impact of medical events on the mission. Copyright (C) 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Updated Etiology and Significance of Elevated Bilirubin During Pregnancy: Changes Parallel Shift in Demographics and Vaccination Status

Abstract

Background

The most common cause of jaundice during pregnancy in the United States (US) is still attributed to viral hepatitis, despite the dramatic drop in incidence of viral hepatitis in the US.

Objective

We hypothesized that viral hepatitis is no longer a frequent etiology of jaundice among the pregnant population in the US and sought to identify the contemporary causes of elevated bilirubin during pregnancy as well as to quantify the associated risk to the mother and fetus.

Study Design

Clinical data from all pregnant women who delivered an infant between 2005 and 2011 at a single hospital in Dallas, Texas, were ascertained using prospectively collected computerized databases. Women with elevated total bilirubin (>1.2 mg/dl) were analyzed to determine the cause of hyperbilirubinemia and maternal and fetal outcomes.

Results

Out of a total of 80,857 consecutive deliveries, there were 397 (0.5 %) pregnancies with hyperbilirubinemia. The most common etiology was gallstones (98/397 = 25 %), followed by preeclampsia/eclampsia/HELLP (94/397 = 24 %) and intrahepatic cholestasis of pregnancy (53/397 = 13 %). Adverse infant outcomes, including stillbirths, fetal malformations, neonatal deaths, and small for gestational age births, were more common in the women with hyperbilirubinemia during pregnancy, but there were no maternal deaths.

Conclusions

Acute viral hepatitis is no longer a common cause of jaundice in pregnant women in the US. In the current era, gallstones and preeclampsia-related disorders are the most common causes of jaundice in pregnant women. Disorders that cause elevated maternal bilirubin during pregnancy are associated with increased risk for the fetus.

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Non-metastatic rectal cancer: Is it time to revisit our approach?

The treatment of non-metastatic rectal cancer has been instated in the past century based on the validation of the chemo-radiotherapy in a neo-adjuvant setting. The incidence of rectal cancer is around 39.000 new cases per year in the United States [1]. The probability of survival at 3 years is approximately 85% with a cumulative incidence of local recurrence about 5% [2]. Treatment is based on the surgical resection with a total meso-rectal excision associated with a preoperative radio-chemotherapy.

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Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of adult isthmic spondylolisthesis

The North American Spine Society's (NASS) Evidence-Based Clinical Guideline for the Diagnosis and Treatment of Adult Isthmic Spondylolisthesis features evidence-based recommendations for diagnosing and treating adult patients with isthmic spondylolisthesis. The guideline is intended to reflect contemporary treatment concepts for symptomatic isthmic spondylolisthesis as reflected in the highest quality clinical literature available on this subject as of June 2013. NASS' guideline on this topic is the only guideline on adult isthmic spondylolisthesis accepted in the Agency for Healthcare Research and Quality's National Guideline Clearinghouse.

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Ablation of the basivertebral nerve for treatment of back pain: a clinical study

Lumbar axial back pain arising from degenerative disc disease continues to be a challenging clinical problem whether treated with non-surgical management, local injection, or motion segment stabilization and fusion.

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Non-metastatic rectal cancer: Is it time to revisit our approach?

The treatment of non-metastatic rectal cancer has been instated in the past century based on the validation of the chemo-radiotherapy in a neo-adjuvant setting. The incidence of rectal cancer is around 39.000 new cases per year in the United States [1]. The probability of survival at 3 years is approximately 85% with a cumulative incidence of local recurrence about 5% [2]. Treatment is based on the surgical resection with a total meso-rectal excision associated with a preoperative radio-chemotherapy.

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Development of the Participation Measure--3 Domains, 4 Dimensions (PM-3D4D): A New Outcome Measure for Rehabilitation

Publication date: Available online 1 September 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Feng-Hang Chang, Tsan-Hon Liou, Pengsheng Ni, Kwang-Hwa Chang, Chien-Hung Lai
ObjectiveTo describe the development of a participation measure that assesses three domains (productivity, social, and community) and four dimensions (frequency, diversity, desire for change, and perceived difficulty) of participation and to evaluate the initial psychometric properties in rehabilitation outpatients.DesignA mixed-method approach included a literature review, item selection, expert reviews, cognitive interviews and field testing with rehabilitation outpatients. A confirmatory factor analysis (CFA) and Rasch analysis were used to validate the construct validity of the difficulty dimension of the instrument.SettingOutpatient rehabilitation programs in Taiwan.ParticipantsAn expert panel consisting of 12 rehabilitation and measurement experts contributed to measurement development; 20 rehabilitation outpatients participated in cognitive interviews; and 556 rehabilitation outpatients (with an average age of 61.36±23.62 years, among whom 53% were male) participated in field testing.Main outcome measureThe Participation Measure--3 Domains, 4 Dimensions (PM-3D4D).ResultsA scoring method for each dimension of the PM-3D4D was established. The instrument displayed good overall model fit in the CFA and unidimensionality across three domains after removing and collapsing locally dependent items identified from a principal component analysis (PCA). However, considering the poor personal reliability of the social subscale and its high correlation with the community subscale, we decided to merge the two subscales into one. The combined subscale showed improved reliability and good construct validity by demonstrating a good model fit (CFI =0.985, TLI =0.982, RMSEA =0.061) and item fit.ConclusionsThe PM-3D4D is a newly developed participation measure designed to assess multiple domains and dimensions of participation by rehabilitation patients. The psychometric analysis results supported the construct of the instrument and helped item revision. Further examination of the validity and reliability of the PM-3D4D will be conducted.



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ND ambulance service awards first-ever ‘Medals of Valor’ to 2 paramedics

By EMS1 Staff

FARGO, N.D. — Two paramedics with F-M Ambulance were recognized for outstanding acts of bravery in the line of duty.

Wednesday's ceremony marked the first time the agency has ever awarded the Medal of Valor, which can only be earned in extraordinary circumstances.

F-M Ambulance Director Sherm Syverson told WDAY TV that it's hard to talk about the specific events leading up to the awards, but confirmed that the paramedics risked their lives in the face of danger to provide care.

Greg Glood, who was off-duty at the time, ran into a burning house to help a person trapped inside. Glood prevented bystanders from entering the house and stayed on scene until ambulances arrived to help treat the patient's injuries.

Kelsey Bodvig responded to an armed standoff as part of the Red River Valley SWAT Tactical EMS team. She provided lifesaving care to a team member at the scene

WDAY reports that both medics served in the U.S. military, and Bodvig will deploy to Kuwait in the coming months.

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Inside EMS Podcast: How to deal with unprofessionalism in EMS

Download this podcast on iTunes, SoundCloud or via RSS feed

In this week's episode of Inside EMS, co-hosts Chris Cebollero and Kelly Grayson discuss the ever-persistent issue of unprofessional behavior in the EMS world. The two offer advice on how to deal with a difficult partner, how to properly begin difficult discussions and how to decrease egotism.

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Effectiveness and safety of vedolizumab for treatment of Crohn’s disease: A systematic review and meta-analysis

Archives of Medical Science

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Detection of anti-HBV drug resistance mutations based on multi-color melting curve analysis

Journal of Clinical Microbiology

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Role of food and aeroallergen sensitization in eosinophilic esophagitis in adults

Annals of Allergy, Asthma, and Immunology

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Micropapillary colorectal carcinoma clinical, pathologic, and molecular properties, including evidence of epithelial-mesenchymal transition

Histopathology

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Health-related quality of life and psychological distress in patients with early-stage hepatocellular carcinoma after hepatic resection or transplantation

Transplantation Proceedings

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Prevalence of celiac disease in first-degree relative of children in Sistan and Baluchestan province (Iran)

Journal of Digestive Diseases

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Serious adverse events reported for antiobesity medicines: postmarketing experiences from the EU adverse event reporting system EudraVigilance

International Journal of Obesity

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Test characteristics of common appendicitis scores with and without laboratory investigations: A prospective observational study

BMC Pediatrics

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Differences in fairness and trust between lean and corpulent men

International Journal of Obesity

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Laparoscopic versus open appendectomy: a retrospective cohort study assessing outcomes and cost-effectiveness

World Journal of Emergency Surgery

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Recognizing the tenascin-X deficient type of Ehlers-Danlos syndrome: a cross-sectional study in 17 patients

Abstract

The tenascin-X (TNX) deficient type Ehlers-Danlos syndrome (EDS) is similar to the classical type of Ehlers-Danlos syndrome. Due to the limited awareness among geneticists and the challenge of the molecular analysis of the TNXB gene, the TNX-deficient type EDS is likely to be under diagnosed. We therefore performed an observational, cross-sectional study. History and physical examination were performed. Results of serum TNX measurements were collected and mutation analysis was performed by a combination of NGS, Sanger sequencing and MLPA. Included were 17 patients of 11 families with autosomal recessive inheritance and childhood onset. All patients had hyperextensible skin without atrophic scarring. Hypermobility of the joints was observed in 16/17 patients. Deformities of the hands and feet were observed frequently. TNX serum level was tested and absent in 11 patients (7 families). Genetic testing was performed in all families; 12 different mutations were detected, most of which are suspected to lead to non-sense mRNA mediated decay. In short, patients with the TNX-deficient type EDS typically have generalized joint hypermobility, skin hyperextensibility and easy bruising. In contrast to the classical type, the inheritance pattern is autosomal recessive and atrophic scarring is absent. Molecular analysis of TNXB in a diagnostic setting is challenging.

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Gastrointestinal Manifestations of Eating Disorders.

Individuals with eating disorders, including anorexia nervosa and bulimia nervosa, may present with a range of gastrointestinal manifestations. The oral cavity, salivary glands, gastrointestinal tract, pancreas and liver can be impacted by nutritional restrictive and binge/purging behaviors. Complications are often reversible with appropriate nutritional therapy. At times, however, the complications in these disorders may be severe, irreversible and even life threatening. Given the often covert nature of eating disorders, the practitioner must be attentive to subtle clues that may indicate their presence. Extensive diagnostic evaluations of the gastrointestinal manifestations of eating disorders should be employed only when nutritional rehabilitation does not remedy the problems. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Rumination Syndrome and Dental Erosions in Children.

Rumination syndrome is the effortless regurgitation of recently ingested food with subsequent re-swallowing or spitting out. Dental erosion (DE) affects 2% to 5% of the population. DE is defined as loss of tooth structure by a chemical process that does not involve bacteria. Our objective was to compare the frequency of DE among children with rumination syndrome with healthy controls. We enrolled 30 patients 4 to 21 years of age diagnosed with rumination syndrome, and 30 age- and sex-matched healthy control subjects. Patients were evaluated by pediatric dentists for presence of DE with Taji et al. a validated grading system. Patients with rumination were more likely to have DE (P

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Response to Letter to the Editor Regarding "Probiotic Administration in Infants with Gastroschisis: a Pilot Randomized Placebo-controlled Trial".

No abstract available

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Gender, Age, and Prevalence of Pediatric Irritable Bowel Syndrome and Constipation in Colombia: A Population-Based Study.

Objectives: Our objective was to evaluate the role of gender and age in the prevalence of irritable bowel syndrome (IBS) and functional constipation (FC) in Colombian children. We hypothesized that the prevalence of IBS and FC would be higher in female adolescents than younger female children, with no corresponding difference in males. Methods: We performed a cross-sectional study of Colombian children. Subjects completed the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III. Subjects were divided into child and adolescent age groups using two different cutoffs. Cutoffs were established at 12 and 13 years (CH-1 = 8-12y, AD-1 = 13-18y, CH-2 = 8-13y, AD-2 = 14-18y). Results: 3891 subjects (47.0% F, mean age 12.0 years) participated. 187 (4.8%) met criteria for IBS. There was no difference in gender composition between CH-1/AD-1 (56.0%, 43.5% F) and CH-2/AD-2 (53.4%, 46.8% F). Prevalence of IBS among females was higher in CH-1 than AD-1 (6.4%, 3.7%, p

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ESPGHAN-NASPGHAN Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children with Esophageal Atresia- Tracheoesophageal Fistula.

Background: Esophageal atresia (EA) is one of the most common congenital digestive anomalies. With improvements in surgical techniques and intensive care treatments, the focus of care of these patients has shifted from mortality to morbidity and quality of life issues. These children face gastrointestinal (GI) problems not only in early childhood but also through adolescence and adulthood. However, there is currently a lack of a systematic approach to the care of these patients. The gastrointestinal working group of International Network on Esophageal Atresia (INoEA) comprised of members from ESPGHAN/NASPGHAN was charged with the task of developing uniform evidence-based guidelines for the management of GI complications in children with EA. Methods: Forty clinical questions addressing the diagnosis, treatment and prognosis of the common gastrointestinal complications in EA patients were formulated. Questions on the diagnosis, and treatment of GER, management of "cyanotic spells", etiology, investigation and management of dysphagia, feeding difficulties, anastomotic strictures, congenital esophageal stenosis in EA patients were addressed. The importance of excluding eosinophilic esophagitis and associated GI anomalies in symptomatic EA patients is discussed as is the quality of life of these patients and the importance of a systematic transition of care to adulthood. A systematic literature search was performed from inception to March 2014 using Embase, MEDLINE, the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Clinical Trials, and PsychInfo databases. The approach of the Grading of Recommendations Assessment, Development and Evaluation was applied to evaluate outcomes. During 2 consensus meetings, all recommendations were discussed and finalized. The group members voted on each recommendation, using the nominal voting technique. Expert opinion was used where no randomized controlled trials were available to support the recommendation. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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A Pilot Study of fMRI Responses to Somatic Pain Stimuli in Youth with Functional and Inflammatory Gastrointestinal Disease.

Background and Aims: Brain-gut axis signaling modifies gastrointestinal symptomatology. Altered neural processing of intestinal pain signals involves interoceptive brain regions in adults with functional and inflammatory gastrointestinal disorders. Although these disorders frequently present in childhood, there are no published studies in youth. We determined if neural processing of somatic pain stimuli differs in adolescents and young adults (AYA) with irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD), as compared to healthy controls (HC). Methods: IBS and IBD AYA (16-20 y) underwent anticipated and thermal pain stimuli of low and high intensity on their forearm and simultaneous blood oxygen level-dependent functional magnetic resonance imaging. Data from adult HC were used for comparison. Subjects answered surveys evaluating alexithymia, anxiety, depression, and pain catastrophizing. Group data were compared using Linear Mixed Effects and ANOVA. Results: Study groups were similar by sex but not age. Significant group by pain condition interactions were observed in interoceptive brain regions during pain anticipation, and within perceptual brain regions during perceived pain. Higher activation within interoceptive brain regions during anticipated pain was observed in IBS compared to IBD and HC subjects. IBD patients demonstrated increased activation in perceptual brain regions during experienced pain as compared to IBS and HC. Conclusions: IBS and IBD AYA demonstrate altered neural processing of somatic pain compared with each other and with HC. Our results suggest that neuromodulatory interventions targeting interoceptive brain circuits in IBS and perceptual brain regions in IBD may be effective. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Cannabis and Pediatric Inflammatory Bowel Disease: Change Blossoms A Mile High.

The trend towards decriminalization of cannabis (marijuana) continues sweeping across the United States. Colorado has been a leader of legalization of medical and recreational cannabis use. The growing public interest in the medicinal properties of cannabis and its use by patients with a variety of illnesses including inflammatory bowel disease (IBD) makes it important for pediatric gastroenterologists to understand this movement and its potential impact on patients. This article describes the path to legalization and "medicalization" of cannabis in Colorado as well as the public perception of safety despite the known adverse health effects of use. We delineate the mammalian endocannabinoid system and our experience of caring for children and adolescents with IBD in an environment of increasing awareness and acceptance of its use. We then summarize the rationale for considering that cannabis may have beneficial as well as harmful effects for IBD patients. Finally, we highlight the challenges federal laws impose on conducting research on cannabis in IBD. The intent of this article is to inform health care providers about the issues around cannabis use and research in adolescents and young adults with IBD. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Physical Activity and Cognitive Development: A Meta-Analysis.

Research Question: Is there an association between regular exercise, defined as a structured program of increased physical activity at least 1 month in duration, and improvements in measures of executive functions compared with children who engage in their normal daily activities? Context: The association between increased physical activity and changes in performance on tasks of executive functions have not been well elucidated in children. Executive functioning is important to intellectual development and academic success in children, and inexpensive, nonpharmacological methods for the treatment of executive dysfunction represent an attractive interventional target. Objective: To estimate the effect of a structured regular exercise program on neuropsychological domains of executive function in children ages 7 to 12. Data Sources: We performed a systematic review of English and non-English articles using Cochrane Library, EBSCO CINAHL, Ovid MEDLINE, PSYCInfo, Pubmed, and Web of Science, including all years allowed by each individual search engine. The search string used was "(exercise OR phys*) AND (cognit* OR executive) AND (child* OR preadolesc*)." The authors of the studies selected for review were contacted for any unpublished data. Study Eligibility Criteria: Randomized controlled trials, which enrolled children between the ages of 7 and 12, with randomization to either normal activity or a structured physical activity intervention consisting of scheduled aerobic exercise, at least once per week, for a period of at least 1 month. Eligible studies must have included a neuropsychological battery of tests that measured at least 1 executive function both before and after the intervention was completed. Study Appraisal: Two independent reviewers examined the screened studies in detail for potential inclusion. The results of the individual examinations were compared; if any discrepancies were present, a third party analyzed the study to determine if it should be included in the meta-analysis. Results: A total of 18 studies were identified by abstract as candidates for inclusion. From these 18 studies, 8 were independently selected by 2 authors for inclusion in the final analysis; there were no selection discrepancies between authors with regard to the studies to be included. In all, 770 subjects were included, 339 in the control group and 431 in the intervention group. All 8 studies contained a measure of inhibitory control; no other domain of executive function was measured frequently enough to perform meta-analysis, so only measures of inhibitory control were pooled and analyzed. A Cohen d effect size was calculated for each measure using the method of Morris for controlled pre-post control measurement studies. The studies were then combined in a random effects model using Comprehensive Meta Analysis software (Biostat, Englewood, NJ) for Windows (Microsoft, Redmond, WA). All studies showed a positive effect of regular exercise with improvements in measures of inhibitory control, but none were statistically significant for this measure. When pooled, the model revealed a combined Cohen d effect size of 0.2 (95% confidence interval, 0.03-0.37; P=0.021), indicating a small improvement of inhibitory control with long-term physical activity. Heterogeneity was very low (I2=0). Limitations: Many studies used different neuropsychological tests to assess inhibitory control, which may have introduced unforeseen confounders. Other domains of executive functions were not measured frequently enough to perform meta-analysis. Despite attempts to gather unpublished data, positive results were observed in all of the included studies, raising the possibility of publication bias. Conclusions and Implications: Increased regular physical activity is associated with a small and measurable, improvement in neuropsychological tests of executive functions, specifically inhibitory control. Executive functions play an important role in complex behavior, and may contribute to academic and career achievement as well as success in social interaction. This finding provides support for the important interaction between exercise and cognitive functioning. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved

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